Saudi Arabia constitutes about four-fifths of the Arabian Peninsula in Southwest Asia and is known to be the third-largest country in Asia, after China and India. The climate is generally cold in winter and dry and hot in summer with temperatures are slightly lower along the coasts. Mostly, Saudi people (or Saudis) have a common Arabian ancestry, making the population generally homogeneous in ethnicity, religion, and language. Arabic is the native language, and English is spoken and understood among most business people, commercial centers, and healthcare workers. Islam is the state religion. The holy city of Makkah is the center of Islam where all Muslims around the world face at prayer. A pilgrimage to Makkah is one of the five basic pillars of Islam for every Muslim who is physically and financially able to perform it. The economy is heavily dependent on oil production, and the country has the largest reserves of petroleum in the world. The government budgets billions of SAR for health and social services. The public health care system is supported by the government, which provides integrated health services free of charge, or at a nominal fee, to all citizens. The private healthcare system also provides excellent healthcare services for people who have healthcare insurances. Again, the government spends billions of SAR for education, which is free at all levels, including college and postgraduate study. There are more than 30 governmental and private universities in the kingdom.
History of Audiology
The field of audiology is relatively new in Saudi Arabia. It is thought that the audiological history in Saudi Arabia goes back to the 1980s when the first audiology and speech-language pathology program was established at King Saud University.
Hearing loss incidence and prevalence
According to the World Health Organization (2012), the prevalence of disabling hearing loss is estimated to be around 0.9% in Middle East countries including Saudi Arabia. The estimated incidence of permanent congenital or early onset hearing impairment in developing countries in 2012 is six cases per 1000 live births (Olusanya, 2012). Zakzouk (1997) reported in an epidemiological study of hearing impairment in children in Riyadh, Saudi Arabia that the prevalence of hearing impairment was found to be 7.5% of the children surveyed; 2.6% of them with sensorineural hearing loss. In another study, Zakzouk et al. (1999) found that the prevalence of hearing impairment among children, who were screened in random areas of Saudi Arabia, was 13% of 10,000 children aged up to 15 years. He reported that 1.5% of the children in Saudi Arabia suffered from either a unilateral or bilateral permanent sensorineural hearing loss. Habib and Abdelgaffar (2005) conducted a study to find the incidence of congenital hearing impairment in Saudi population. A total of 11986 non-high-risk neonates were screened by transient evoked otoacoustic emission over a period of 8 years. They estimated the incidence of sensorineural hearing loss to be 0.18% with no significant difference between males and females. In a cross-sectional study of 2,574 children aged 4-8 years old, Al-Rowaily et al. (2012) diagnosed 45 children with hearing impairment with an overall prevalence of 1.75%.
INFORMATION ABOUT AUDIOLOGY
The first audiology and speech-language pathology program was established at King Saud University about 30 years ago, whereas the Saudi Society of Speech-Language Pathology and Audiology (SSSPA) was officially established in 2003 (SSSPA, 2014). The idea of establishing new audiology and speech-language pathology programs in some education facilities has become popular across Saudi Arabia; yet, only four undergraduate and graduate programs are currently available. At present, Saudi universities offer three undergraduate programs and only one graduate program in audiology and/or speech-language pathology, of which two are governmental and one is private. King Saud University offers a combined undergraduate program (i.e., a dual degree program) in speech and hearing rehabilitation for male and female students. Princess Nourah Bint Abdulrahman University provides two separate undergraduate programs in audiology and speech-language pathology for female students. Dar Al-Hekmah University offers undergraduate and graduate programs in speech-language pathology for female students (SSSPA, 2014).
Audiology Practice : Public Vs Private
Most audiologists practicing in Saudi Arabia are Saudi citizens with different levels of experience. Audiologists, who are mainly working in governmental hospitals as full-time workers, serve different numbers of geriatric and pediatric patients on a daily basis. However, main government hospitals, rehabilitation centers and schools in Saudi Arabia hire a few graduated audiologists. There are several reasons, but the lack of understanding of professional services provided by audiologists and the complexity of recruitment policies and procedures are the main reasons.
Services offered by Otolaryngologists, Otologist's & Otoneurologists
Ear related services provided by ENT doctors in Saudi Arabia include diagnosis and medical and surgical treatment of ear pathologies, balance disorders of all ages, from common conditions to some of the most complex medical cases. Cochlear implants and bone anchored hearing aids have become among the most common surgical procedures in Saudi Arabia. Other common procedures, such as the placement of ventilation tubes, tympanoplasty, mastoidectomy, and hearing reconstruction with prosthetic ossicles are also conducted in the main hospitals. The other hearing related service provided by nurses is the hearing screening for newborns. Nurses are mainly responsible for performing newborn hearing screenings in hospitals that have the newborn hearing screening program.
Audiologists practicing in Saudi Arabia provide several audiological services. Summary of audiology services is shown in the following Figure.
Figure 1. Summary of audiology services and the percentage of audiologists. OAEs: Otoacoustic emissions, PTA: Pure tone audiometry, H. phones: Headphones, I.E. phones: Insert earphones, SRT: Speech recognition threshold, SDT: Speech detection threshold, WRS: Word recognition threshold, ABR: Auditory brainstem response, ASSR: Auditory steady-state response, CIs: Cochlear implants; Re/hab: Re/habilitation, APD: Auditory processing disorder, M.E.Is: Middle ear implants, NHS: Newborn hearing screening, and H.P.P.: Hearing protection program (Alanazi, 2017).
There is no available data about the number of licensed audiologists or other hearing health related specialists practicing (e.g., speech-language pathologists) in Saudi Arabia. The Saudi Commission for Health Specialties (SCHS), which conducts licensure examinations for native and foreign diplomats and foreign nationals before they may practice in Saudi Arabia ensuring quality of care, should announce these numbers.
PROFESSIONAL AND REGULATORY BODIES
The Ministry of Education supervises and regulates all academic programs including audiology programs in all universities. Moreover, it accredits all foreign qualifications in audiology and other academic fields. SCHS conducts licensure examinations for native and foreign diplomats and nationals before they may practice in Saudi Arabia. Saudi Society of Speech-Language Pathology & Audiology (SSSPA) works to develop audiology profession through connecting audiologists with each other and with other professionals, providing scientific advice in the field of audiology, encouraging theoretical and clinical scientific research, and facilitating the exchange of scientific production, scientific ideas in the interests of association between relevant bodies and organizations within and outside Saudi Arabia.
SCOPE OF PRACTICE AND LICENSING
An undergraduate degree in audiology is mandatory to practice audiology in Saudi Arabia. Before graduation, audiology students must complete a 12-month (or a 6 month if the program is combined) supervised internship in audiology clinics. After graduation, audiologists must be licensed by SCHS to practice in Saudi Arabia.
CHALLENGES, OPPORTUNITIES AND NOTES
The current undergraduate programs are not enough to cover the high demand of audiology services in Saudi Arabia. Trained audiologists will be increasingly needed to meet the demands of the community. More undergraduate and graduate programs must be established. The efforts aiming to establish academic programs in Saudi Arabia may encounter a number of obstacles, such as complexity of regulations and shortage of faculty with research and academic degrees. Further, there are other challenges, one of which is the national accreditation of the clinical doctorate programs (i.e., Doctor of Audiology [Au.D.] programs). The Ministry of Education in Saudi Arabia accredits Au.D. degree as a bachelor degree. The Au.D degree should be equivalent to at least a master’s degree for a person who already had an undergraduate degree.The profession of audiology is still in its infancy in Saudi Arabia. Cooperation among a diverse group of stakeholders, including SSSPA, SCHS, current audiology academic program directors and faculty members, Ministry of Health, Ministry of Education, and King Salman Center for Disability Research should be started and supported to achieve better education and practice and encourage research.
Alanazi, A. A. (2017). Audiology and speech-pathology practice in Saudi Arabia. International Journal of Health Sciences, 11(5), 43-55.
Al-Rowaily, M, A, AlFayez, AI., AlJomiey, M. S., AlBadr, A. M., & Abolfotouh, M. A. (2012). Hearing impairments among Saudi preschool children. International Journal of Pediatric Otorhinolaryngology, 76(11), 1674-1677.
Habib, H. S., & Abdelgaffar, H. (2005). Neonatal hearing screening with transient evoked otoacoustic emissions in Western Saudi Arabia. International Journal of pediatric Otorhinolaryngology, 69(6), 839-842.
Olusanya, B. O. (2012). Neonatal hearing screening and intervention in resource-limited settings: An overview. Archives of Disease in Childhood, 97, 654-659.
Zakzouk, S. M. (1997). Epidemiology and etiology of hearing impairment among infants and children in a developing country. Part I. Journal of Otolaryngology, 26, 335-344.
Zakzouk, S. M., Daghistani, K. J., Jamal, T. S., Al-Shaikh, A. A., Hajjaj, M. F. (1999). A survey of childhood hearing impairment. Saudi Medical Journal, 20, 783-787.
MEET OUR AUTHORS
Dr. Ahmad Alanazi (PhD, AuD) is an assistant professor at King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. He has completed his PhD and AuD degrees from University of Arkansas for Medical Sciences, USA, his maters’ degree from Flinders University, Australia, and his bachelor’s degree from King Saud University, Saudi Arabia. He had worked as an adjunct clinic instructor and lecturer at University of Arkansas for Medical Sciences. His research interests are broad but mainly focus on early hearing detection and intervention, simulation, and interprofessional education and practice in which he has published several papers in peer-reviewed journals. His recent research focuses on the collaborative work between healthcare professionals in meeting the 1-3-6 timeline via the use of simulation.